Teaching Clinical Reasoning and Critical Thinking: From Cognitive Theory to Practical Application

Jeremy B Richards, Margaret M Hayes, Richard M Schwartzstein
Chest 2020, 158 (4): 1617-1628
Teaching clinical reasoning is challenging, particularly in the time-pressured and complicated environment of the ICU. Clinical reasoning is a complex process in which one identifies and prioritizes pertinent clinical data to develop a hypothesis and a plan to confirm or refute that hypothesis. Clinical reasoning is related to and dependent on critical thinking skills, which are defined as one's capacity to engage in higher cognitive skills such as analysis, synthesis, and self-reflection. This article reviews how an understanding of the cognitive psychological principles that contribute to effective clinical reasoning has led to strategies for teaching clinical reasoning in the ICU. With familiarity with System 1 and System 2 thinking, which represent intuitive vs analytical cognitive processing pathways, respectively, the clinical teacher can use this framework to identify cognitive patterns in clinical reasoning. In addition, the article describes how internal and external factors in the clinical environment can affect students' and trainees' clinical reasoning abilities, as well as their capacity to understand and incorporate strategies for effective critical thinking into their practice. Utilizing applicable cognitive psychological theory, the relevant literature on teaching clinical reasoning is reviewed, and specific strategies to effectively teach clinical reasoning and critical thinking in the ICU and other clinical settings are provided. Definitions, operational descriptions, and justifications for a variety of teaching interventions are discussed, including the "one-minute preceptor" model, the use of concept or mechanism maps, and cognitive de-biasing strategies.

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